Systemic Therapy in Older Patients With High-Risk Disease

Area of Science:

• Geriatric Oncology
• Breast Cancer Therapeutics
• Clinical Decision-Making

Background:

• Adjuvant systemic treatments for older breast cancer patients often require dose or schedule modifications compared to younger individuals.
• Frailty, common in patients over 70, increases the risk of adverse events from chemotherapy, endocrine therapy, and targeted treatments.
• Pharmacokinetics can be misleading in older adults due to age-related declines in functional reserves.

Purpose of the Study:

• To highlight the challenges and necessary adjustments in adjuvant systemic treatments for older breast cancer patients.
• To emphasize the importance of geriatric assessment and patient-centered care in optimizing treatment decisions.
• To advocate for integrating molecular testing with geriatric factors for comprehensive adjuvant treatment planning.

Main Methods:

• Review of challenges in adjuvant therapy for older breast cancer patients, including frailty, side effects, and pharmacokinetic alterations.
• Analysis of the impact of geriatric assessment on treatment decisions, noting significant changes and de-escalation rates.
• Consideration of patient expectations, quality of life, and the role of multimorbidity in treatment outcomes.

Main Results:

• Geriatric assessment integrated into multidisciplinary teams led to 30%-50% changes in treatment decisions, de-escalating therapy in two-thirds of cases.
• Older patients prioritize functionality, cognitive health, and independence, often conflicting with standard dose-intensity models.
• Molecular testing for high-risk tumors should be combined with geriatric factors for better adjuvant treatment selection.

Conclusions:

• Adjuvant treatment decisions for older breast cancer patients must account for frailty, comorbidities, and individual patient goals, prioritizing quality of life.
• A shift from age-agnostic protocols to personalized approaches, incorporating geriatric evaluations and patient preferences, is essential.
• Combining advanced molecular diagnostics with comprehensive geriatric assessments offers a more holistic strategy for optimizing adjuvant therapy in elderly breast cancer survivors.